Prescription drug misuse (PDM) occurs when a person uses a medication in a way other than intended by the prescribing clinician. This includes taking a larger dose than directed, using the drug for the feeling of euphoria or “high,” or consuming medication prescribed for someone else. PDM spans different drug classes, with opioids (for pain), central nervous system depressants (for anxiety and sleep), and stimulants (for ADHD) being the most commonly misused. Recognizing the early warning signs of PDM allows for early intervention, which can prevent escalation into a severe substance use disorder or addiction.
Behavioral and Social Indicators
Observable shifts in a person’s routine, personality, and social life often serve as the first noticeable indicators of prescription drug misuse. A person may suddenly become highly secretive about their activities or whereabouts, often exhibiting a defensive or hostile reaction when questioned. This increased secrecy is frequently coupled with dramatic and unpredictable mood swings, which can range from intense irritability and anxiety to unexplained periods of euphoria or depression.
The ability to manage daily obligations typically declines as the misuse progresses. An individual may begin neglecting responsibilities at work, school, or home, leading to poor performance or a complete withdrawal from previously enjoyed activities and hobbies. Socially, there may be a sudden change in friend groups, or the person may isolate themselves, avoiding family gatherings and established social circles.
Financial strain can also become apparent, manifesting as unexplained requests for money, missing money or valuables from the home, or an inability to account for personal funds. Lying about their activities or drug use becomes a pattern, as they attempt to conceal the extent of their misuse from others.
Physical and Health Symptoms
The physical effects of prescription drug misuse vary significantly depending on the drug class, yet several common health symptoms can be observed. Changes in sleep patterns are frequent, presenting as profound drowsiness, poor concentration, and excessive sleeping with opioids and depressants, or as persistent insomnia and agitation with stimulants. Poor coordination, unsteady walking, slurred speech, and dizziness are common symptoms associated with central nervous system depressants.
Stimulant misuse often leads to physical signs like an irregular heartbeat, high blood pressure, and a reduced appetite, which may result in sudden, unexplained weight loss. Conversely, opioids can cause constricted, pinpoint pupils, nausea, and chronic constipation. A decline in personal grooming and hygiene may also be observed, as the person becomes less concerned with self-care.
When a person who is physically dependent on a drug attempts to stop or reduce their dose, they may experience withdrawal symptoms. These symptoms often mimic a severe flu, including muscle aches, sweating, vomiting, and anxiety. The presence of these flu-like symptoms when the drug is unavailable can be a strong indicator of physical dependence.
Indicators Related to Prescription Management
Behaviors directly related to obtaining or handling medication are highly specific indicators of prescription drug misuse. One of the most common signs is running out of a prescribed medication well before the next refill is scheduled, which often leads to frequent, unscheduled requests for early refills. This behavior signals that the person is taking a higher daily dose than prescribed or is using the drug more frequently.
Another clear sign is “doctor shopping,” which involves visiting multiple prescribers to obtain overlapping prescriptions for the same or similar controlled substances. This practice is sometimes combined with “pharmacy shopping,” where the person fills prescriptions at several different locations to avoid detection. The need for higher doses is often driven by a developing tolerance, where the body adapts to the drug, reducing its effect and requiring more of the substance to achieve the desired result or to simply avoid withdrawal.
The physical alteration of medication is a serious indicator, such as crushing pills meant to be swallowed whole so they can be snorted or injected for a more rapid and intense effect. Other concerning actions include claiming prescriptions were lost, stolen, or damaged to justify a request for a replacement, or the stealing of pills from family members, friends, or medicine cabinets. Finding paraphernalia like bent spoons, cotton balls, or syringes that are inconsistent with a person’s medical needs can also suggest that the medication is being used in an unapproved manner.
What to Do After Recognizing the Warning Signs
Once warning signs are recognized, the next step is to initiate a supportive and empathetic dialogue with the person of concern. It is important to approach the discussion without judgment, focusing instead on observable behaviors and expressing concern for their health and well-being. The goal of this initial conversation is not to diagnose or confront, but to encourage them to seek professional help.
Consulting with a healthcare provider, such as the prescribing physician or a primary care doctor, is necessary to ensure a professional assessment. These medical professionals can accurately evaluate the situation and determine the appropriate level of care, which may include a medically-supervised detoxification to manage potential withdrawal symptoms safely. Treatment from addiction specialists can include individual, family, or group counseling. Resources for immediate support, such as national helplines and online directories for treatment facilities, should be provided to facilitate the next steps toward recovery.